Provider Demographics
NPI:1093875247
Name:ARNOLD, JENNIFER SYLVIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SYLVIA
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:SYLVIA
Other - Last Name:RIDDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:411 WILLIAMS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2748
Mailing Address - Country:US
Mailing Address - Phone:425-207-3642
Mailing Address - Fax:425-277-3897
Practice Address - Street 1:411 WILLIAMS AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2748
Practice Address - Country:US
Practice Address - Phone:425-207-3642
Practice Address - Fax:425-277-3897
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00064847183500000X, 1835P1200X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00064847OtherLISENSING NUMBER